The disproportionate burden of HIV/Aids borne by women and girls in most developing countries requires urgent attention. At the heart of the problem is profound gender inequality and inequity, coupled with the systematic disempowerment of women, condoned by society for generations.
Although a global problem, it is particularly evident in developing countries and the HIV/Aids epidemic, therefore, is merely exposing the underlying failures of society.
Comprehensive sexual education for adolescent boys and girls is probably the single most important intervention in correcting gender stereotypes and imbalances and for preventing violence against women and the further spread of HIV.
Unfortunately, reproductive health services for women and girls in developing countries are universally not up to standard. Services that need urgent attention include family planning, antenatal, perinatal and postnatal care, diagnosis and treatment of sexually transmitted infections, including HIV, early diagnosis and treatment of cancer of the cervix and access to safe and legalised abortion. In fact, criminal abortion is rife and extremely dangerous in developing countries, accounting for about 12% of all maternal mortality.
Female condoms have also not been given a chance as an important female-controlled method of preventing HIV infection and unwanted pregnancy. When women are properly counselled and trained in the use of female condoms, there is a high acceptance and demand for their availability. The female condom is particularly effective in violent or non-consensual relationships. Much greater investment into its research and development needs to be made.
Much publicity has been given to the microbicide gel containing the antiretroviral drug tenofovir in the prevention of HIV infection. The fact that it appears to be 40% effective shows promise for the female-controlled method of prevention.
Dr Brian Brink is chief medical officer of Anglo American and the chair of the International Women’s Health Coalition